Dual-Diagnosis
Dual-Diagnosis refers to the coexistence of a substance abuse problem, specifically alcohol or drug abuse, in association with an underlying emotional or psychological illness. The term co-occurring disorders can also utilized. Persons with a dual-diagnosis face the challenge of dealing with substance abuse and psychological illness, which work together to compromise the person's ability to address either problem. Furthermore, either disorder can cause the person to relapse or deteriorate in the other disorder. Persons with a psychological problem who have become dependent on alcohol or drugs have much more difficulty staying sober when their psychological issues become problematic. Alcohol and drug problems are highly prevalent in persons with depression, bipolar disorder, personality disorders and schizophrenia. Interestingly, the same regions of the brain are involved in chemical dependency and many psychiatric problems. Up to 50% of persons diagnosed with a psychological illness abuse alcohol or drugs.
Treatment of a Client with a Dual-Diagnosis may be very difficult. Psychiatric symptoms may be masked by substance abuse. Alcohol or drug use or withdrawal can mimic psychiatric symptoms. Untreated chemical dependency can contribute to the onset or recurrence of a psychiatric illness. Accordingly, it may be difficult to make a correct initial diagnosis when multiple issues are concurrent, which can make subsequent treatment ineffective or even counterproductive.
Drug abuse, including alcoholism, narcotic addiction, and prescription drug abuse can induce symptoms consistent with mental illness, during both the acute intoxication stage and withdrawal stage. Psychiatric symptoms can persist long after drug use has ceased, such as prolonged psychosis or depression after metamphetamine or cocaine use. Marijuana and hallucinogens can produce delusional behavior and psychosis long after use has stopped. Severe anxiety and depression are associated with alcohol abuse. Conversely, persons with a psychological problem, such as anxiety disorder, depression, bipolar disorder, psychological trauma, or personality disorder, may use drugs or alcohol to self-medicate.
What are the challenges of making a Dual Diagnosis?
As discussed, separating out symptoms related to substance abuse from underlying psychological symptoms can be a diagnostic challenge. Persons with a Dual Diagnosis should be evaluated by a mental health professional with experience in Dual Diagnosis. Interviews with the Client, as well as with his or her family, provide valuable initial information. However, it is often difficult to determine what drugs or medications a person with a psychological problem may be using to self-medicate. A thorough evaluation of current behaviors is performed delineating how they have interfered with the Client’s everyday living, including negative effects on family, friends, work or school. The Client’s family history is also explored, including relatives with a history of psychiatric or substance abuse problems.
What is the Prognosis for a person with a Dual Diagnosis?
Although there are many pitfalls, once the proper diagnoses are made, Dual Diagnosis can be effectively managed. Substance abuse, self-medicaion, or alcohol abuse must be controlled or eliminated first, before a person can focus on the underlying psychological issues that may be the driving force behind their addiction. Psychological disorders are then treated with psychotherapy and when necessary, medication. Effective individual and group psychotherapy, sleep and stress management, and psycho-education are important to help a person with Dual Diagnosis recover and heal from both their addictive and psychological issues.
What factors can slow recovery?
Persons with a Dual Diagnosis may be imparied or in crisis, and thus unable to seek help for themselves. It is important to find a mental health professional or treatment facility that has expertise in Dual Diagnosis, as establishing the proper diagnosis and treatment plan is intricate and often complex. Persons with a Dual Diagnosis may be in conflict with family or loved ones, thus lacking an effective social support structure. They may be unemployed, lacking financial resources. They may also be suffering from medical problems related to their substance abuse, further impairing their ability to begin treatment.
How Can Friends and Family Help?
Dealing with a family member suffering from addiction and psychological illness is extremely difficult. Family and friends need to educate themselves to understand how to help a person with Dual Diagnosis find the right treatment center and begin therapy. Family can ensure that the person participates in treatment, and they can monitor for signs of relapse or crisis. Family members are likely to help a person with a Dual Diagnosis enter a treatment facility, providing social and financial resources.
When Should a Client enter a treatment center?
When a person with Dual Diagnosis is having serious problems that are negatively impacting their daily school or work life and personal and family relationships, an intensive treatment program is an appropriate option. In times of crisis, or impairment, family members can feel more assured that their loved one is in a safe and more containing place. Once per week psychotherapy or medication may be insufficient to manage substance abuse and psychological illness. A treatment facility, like PCH Treatment Center, is a definitive step towards healing and recovery in a person with Dual Diagnosis.
How does PCH Treatment Center treat Dual Diagnosis?
Traditionally, substance abuse problems have been treated in a more intense or confrontational manner when compared to psychological problems, which are addressed in a more supportive, non-confrontational manner. PCH Treatment offers an integrated program for Clients with a Dual Diagnosis, which balances these treatment approaches. We feature therapists with specific expertise in working with Clients with Dual Diagnosis in an immersive setting. Dr. Jeff Ball, the Executive and Clincial Director, has over 25 years of experience treating persons with serious psychological problems. He has assembled a highly qualified treatment team with expertise in addressing psychological issues associated with substance abuse and alcoholism. Upon entrance, each Client receives a thorough initial assessment by a doctoral level psychologist. In conjunction with Dr. Ball and the entire treatment team, an accurate diagnosis is made, separating out the addiction issues from the psychological problems. Dr. William Wirshing, the PCH Treatment Center Psychiatrist, evaluates each Client to determine what medications, if any, they need to be taking. Individual psychotherapy is conducted up to five times per week, in conjunction with Dialectical Behavioral Therapy (DBT), EMDR, anger management, sleep hygeine, psycho-education, neurofeedback and other modalities. Holistic therapies including yoga, mindfulness meditation, acupuncture and massage therapy are important for recovery and healing. Family therapy groups are also available. These valuable groups incorporate family members or significant others into the Client’s treatment environment to strengthen their support system. PCH Treatment Center addresses Dual Diagnosis with a broad array of resources and experience in our immersive treatment setting.
